AUTHOR=Diaz-Riera Elisa , García-Arguinzonis Maisa , López Laura , Garcia-Moll Xavier , Badimon Lina , Padró Teresa 

TITLE=Vitamin D Binding Protein and Renal Injury in Acute Decompensated Heart Failure

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.829490

DOI=10.3389/fcvm.2022.829490

ISSN=2297-055X

ABSTRACT=Background: Renal function in acute decompensated heart failure (ADHF) is strong predictor of disease evolution and poor outcome. Current biomarkers for early diagnostic of renal injury in the setting of ADHF are still controversial and their association to early pathological changes needs to be established. By applying a proteomic approach, we aimed to identify early changes in the differential urine protein signature associated with development of renal injury in patients hospitalised due to ADHF.
Material and methods: Patients (71 [64-77] years old) admitted at the emergency room with ADHF and hospitalised were investigated (N=64). Samples (urine/serum) were collected at hospital admission (day 0) and 72 hours later (day 3). Differential serum proteome was analysed by two-dimensional electrophoresis and MALDI-ToF/ToF. Validation studies were performed by ELISA.
Results: Proteomic analysis depicted urinary vitamin D binding protein (uVDBP) as a two spots protein with increased intensity in ADHF and significant differences depending on the glomerular filtration rate (GFR). Urinary VDBP in ADHF patients at hospitalisation was >3fold higher than in healthy subjects, with the highest levels in those ADHF patients already presenting renal dysfunction. At day 3, urine VDBP levels in patients maintaining normal renal function dropped to normal values (P=0.03 vs day 0). In contrast, urine VDBP levels remained elevated in the group developing renal injury, with values 2fold above the normal range (P<0.05), while serum creatinine and GF levels were within the physiological range in this group. Urinary VDBP in ADHF positively correlated with markers of renal injury such as cystatin C and KIM-1 (Kidney Injury Molecule 1). By ROC-analysis, urinary VDBP, when added to cystatin C and KIM-1, improved the prediction of renal injury in ADHF patients.
Conclusions: We showed increased urine VDBP in ADHF patients at hospital admission and a differential uVDBP evolution pattern at early stage of renal dysfunction, before pathological worsening of GFR is evidenced.